Botulinum toxin management of spasmodic dysphonia (laryngeal dystonia): A 12‐year experience in more than 900 patients

The Mayo Clinic Arizona Spasmodic Dysphonia Experience

“…Blitzer 12 showed a 12% family history of dystonias in his population group. 18 In our study, positive family history of spasmodic dysphonia was present in only 6 patients (0.8%) and of other dystonias in 11 patients (1.5%). The possibility of such a large difference may exist in the population differences between the group treated by Blitzer, 12 which includes a higher population of dystonia patients and hereditary dystonia patients.…”

“…Tremor in a spasmodic dysphonia patient may be a co-prevalent essential tremor or a dystonia tremor. 13,[15][16][17][18] Vocal tremor was present in 54.5% of our patients. Our study demonstrates a higher number of spasmodic dysphonia patients afflicted with concomitant vocal tremor.…”

Spasmodic dysphonia: a seven-year audit of dose titration and demographics in the Indian population

“…Blitzer et al recommended giving such patients a large unilateral dose, followed by a smaller dose in the contralateral vocal fold two weeks later. 4 In a 2013 study by Rosow et al, it was observed that patients injected with 1.25 U bilaterally had a significantly shorter duration of breathiness of voice compared with patients in other studies that used standard doses of botulinum toxin (2.5 U), with no significant difference in clinical effectiveness or voice outcome. The authors therefore recommended a relatively low initial botulinum toxin A dose with subsequent titration, to improve voice outcomes (Table I).…”

“…3 The adductor variety is more common than the abductor type, with the former affecting around 80 per cent of persons with spasmodic dysphonia. 4 In the case of abductor spasmodic dysphonia, a typical breathy spasm is observed and is almost always accompanied by a flaring of the ala nasi. In a prospective, doubleblinded, controlled study of 24 cases of proven abductor spasmodic dysphonia, visible and detectable flaring of the ala nasi, as a constant recurring pattern, was observed (in contrast to a control group).…”

Pyridostigmine for Reversal of Severe Sequelae From Botulinum Toxin Injection

“…[8][9][10] Despite its safety record, botulinum toxin carries a small risk of severe adverse sequelae. [11][12][13] These effects may result from local or systemic spread days to weeks after the injection and can include such varied symptoms as dysphonia, dysphagia, difficulty breathing, and muscle weakness, and autonomic symptoms. 14 Pyridostigmine (Mestinon; Valeant Pharmaceuticals International, Aliso Viejo, CA) is a reversible acetylcholinesterase inhibitor approved by the Federal Drug Administration for treatment of myasthenia gravis.…”